Wherein a surgeon tells some stories, shares some thoughts, and occasionally shoots off his mouth. Like a surgeon.

Wednesday, August 12, 2009

One Small Step

If anyone here reads Andrew Sullivan's blog, runs across this post, and finds anything familiar in the writing, there could be a reason... Anonymity doesn't do much for blog traffic, but any way to spread the word...

The word, of course, is the extent to which health care reform is aimed at doing things that will be helpful. Even -- especially! -- for those very people who yell and weep and carry guns to meetings, spouting verbatim the insane ravings of Glenn Beck and Sarah Palin while having not the slightest idea what they're really talking about. "Keep government out of Medicare," they say. "Socialism."

The "socialism" trope may be the most laughable (were it actually funny): all of the proposals on the table fall over themselves to maintain the death-grip insurance companies have on us. (Talk about "death panels!" What is it when insurers deny coverage?) None talks about nationalizing the health care delivery system. Not even Medicare is socialism. Single payer -- which in my mind is the only option that makes sense, and which, like Medicare is NOT socialism -- is, clearly, off the table.

There's no possible health care reform package that will satisfy everyone; nor, given the way Congress works, one that will be free of pork-fat, undue complexity, or unexpected consequences that will need to be addressed. Still, what the various iterations seem to have in common are regulations to prevent rescission, to create portability, to remove limits on lifetime coverage, to banish denial for pre-existing conditions. Is it really possible that any of the screamers are against those reforms?

Cost is most certainly an issue, and there is a multitude of ways to address it. Starting, from the doctors' part, with the sort of thing mentioned in that Andrew Sullivan post. Only the surface has been scratched there. And, long after I'm dead, assuming the country still exists, I predict single payer will have come to pass, and people will be glad for it. Even the gun-totin' America lovers.

Signs at the meetings -- ignoring the ones showing Obama as Hitler, a completely ludicrous meme hatched and promoted at Fox "News" (sic) and ingested without chewing by its self-pitying listeners -- point out that Medicare is "bankrupt." While not yet true, it's a point worth considering. To the extent that it hasn't enough money, it's not the fault of Medicare, which spends far less on non-medical expenses than any private insurer. It's because of funding. It's because of the holdover idea from the Reaganomics that you can have what you want without paying taxes.

So, what if everyone were covered by a Medicare-like program, and no one paid premiums; or if there were the sorts of premiums and co-pays associated with Medicare? Currently I pay $14K/year in premiums for me and my wife. Would I be happy to have taxes raised in another area, even, say, by $10K/year? Who wouldn't take that trade? By getting rid of the 30% skim by insurers, that math works right away. And by taking seriously -- instead of demagoging as "death panels" -- the idea of finding cost savings in more efficient care, much more than that will be saved.

And yet, they rave and froth. Getting crazier and scarier. Arguing, in effect, for maintaining a system in which their premiums have likely more than doubled in the last ten years, which covers them sparingly, cutting them off when they need it most: sick, out of work. And they are ready to draw weapons over a plan to pay for help writing the very instructions that will keep them in charge of their care when they're unable to make decisions for themselves.

Who'd have thought people so in need of health care reform could be whipped into a froth by people who lie so freely and make easily refutable claims? I remain unable to understand. And bereft of hope.

26 comments:

I had the "pleasure" of deciding for my elderly mother which policy she should use for her Plan D prescription drug insurance. What a nightmare! I became convinced that the "plan" was useless. It did save Mom some money the first year, but once the insurance company was able to drop certain drugs from their coverage, there was no way that she reaped any benefit whatsoever. The language of many of the policies was inscrutable to me, a college-educated person. If my mother had had to choose her own policy, she would have been totally lost. I am convinced that the insurance companies banked on the fact that most seniors would not understand what they were being offered.

The healthcare reform in the offing will be useless if we have to go through the same thing with our own health insurance. What I want is a single-payer system just like the original Medicare Plan A. If, instead, we are saddled with numerous insurance companies competing with each other for our choice, we are doomed. And I believe that the insurance companies will engage in price-fixing so that they will continue to reap the huge profits that they now enjoy.

I'm all for Freedom of Speech, but I'm terribly afraid that the nitwits who are showing up for the recent town meetings to protest healthcare reform will sway enough legislators to ruin everything...Classof65

Sid, have you ever been to Walt Disney World? Grab a grandkid or two, and my family and I will be your guides to the happiest place on earth. Think about how much fun it would be to get away from ALL OF THIS. To truly leave your problems and emotions behind. My 5 year old has been begging to go, and my wife likes visiting with people who have never been so she can show off her Disney Dork skills. I could even help find you a good deal online. So if you're interested and meeting up as two friendly families there, email me. I know everything there is to know about Disneyland... I used to work there selling vacation package.

He did mis-state the amputation cost thing. The TOTAL cost of an amputation is likely 50K. Which, as anyone who thinks would know, is what he meant. But, yeah, it was a mistake. And, of course, he neither said nor implied that docs refuse to treat diabetes so they can do the amputation.

But your comment does highlight the sort of discourse we're having. It's one thing for the lobbyists to promote the drivel. It's quite another when the very people who need reform so badly eat it up like ice cream.

This 'death panel' tripe from Palin is irritating as hell. Why does she equate the UK's health system with lining patients up and denying them treatment?! It's insanity. I know the NHS isn't perfect, but it's there for people when they need it. Watching the BBC news last night and seeing a woman stand up at a town hall meeting in the US and screech that by socialising medicine, the US would essentially become Russia (or something along those lines) was embarrassing and misguided.

I'm starting to lose some respect for some American's ability to listen and think after someone on twitter told me they hoped I get cancer after I said I supported the NHS (I'm from the UK). Glad to see there are people out there like you Sid who are listening and realised it's pretty bad when over 50 million Americans have no insurance...

First of all I have followed your blog for a couple of years now and have always enjoyed your incite.

It's very sad that we as a country debate health care as if it is another bipartisan shit show.

Yes, changes in health care are necessary but I don't think any progress will be made in the current political environment. Understanding and the loss of stupid political bullshit must stop before meaningful and drastic changes can occur.

Parameddan: good question. I really think our politics has gotten so partisan and stupid that something as complicated -- and important!! -- as health care reform is simply beyond us nowadays. As you say: too much stupid, too little real thought.

Sid, you ought to contact Andrew Sullivan and ask that he re-run your comments with attribution and blog contact information. What he did is not good practice, but you have to decide where to put your emphasis. Your writing is superb -- most of us who come here know that, but so should others.

Identifying sources -- unless they are "off the record" -- is important in writing as you well know. Andrew Sullivan should really know that. Regrettably, he doesn't accept comments on his work so you cannot use that route to even protest. However, I'm sure he has an email address, and so do his superiors. It depends on how much of a fuss you want to make.

Do you even know how Sullivan happened to pick up your comments? Did you send them directly to him via some route... or what happened?? Just curious about the "chain of custody" of your remarks!

I emailed him. It's how he's always run his blog: he doesn't allow comments, but he reads emails and publishes some of them as he chooses, always without naming the writer. It's what he does, everyone who reads him knows it, and finds it acceptable, including me. I didn't write it for aggrandizement, but to make a point, and I knew that if he published it, it would be anonymous. Not a problem. Given that it's one of the most widely read and influential blogs on the planet, I'm proud that he (he's actually off for a while and his assistants are running the blog) chose my comment to print.

On more than one occasion he's asked his readers about allowing comments, and they always vote in favor of keeping it as it is. He posts plenty of opposing views.

"The American College of Surgeons is deeply disturbed over the uninformed public comments President Obama continues to make about the high-quality care provided by surgeons in the United States. When the President makes statements that are incorrect or not based in fact, we think he does a disservice to the American people at a time when they want clear, understandable facts about health care reform. We want to set the record straight."

Yeah, I got that statement emailed to me from the ACS. I thought it was a little strong, given the obvious misstatement. But when I heard Obama say that, and the thing about tonsils, I knew there'd be blowback. I must say Obama has been less than eloquent on some occasions, and it's bothered me. On the other hand, he's far superior to what we've had for the last eight years, and his aims are right. So I excuse it.

I agree with you, of course, but it has begun to bother me more lately. I voted for the president because I thought he had thought these things out thoroughly, but more and more it sounds like he's just making it up as he goes along. Also, the statements from people who should know better about not having read their various bills.

Well, I share your concerns. The evident deal with drug companies, for example, and what appears to have been too much optimism that with the clear need for reform and a "mandate" to do something about it, that there'd be bipartisan efforts to get it done. I think the level of vitriol and the rank lying may have surprised him. His town hall meetings may help; but they let the message get taken over by the RWS™ who have absolutely no compunction about lying outright.

The extent to which he's making it up as he goes along? Don't know. Remains to be seen. I guess I'm more realistic than I may have been, but far from ready to give up on him.

It's sure nice to know that the ONLY mis-statements Obama has made about healthcare reform relate to poor treatment by doctors. Thank goodness he's 100% right on everything else.

It's good to know that people advocating socialized medicine can point to those who have experience with it and their strong endorsement of its outcomes. Such as this report:

"The Patients Association has campaigned for many years to improve the quality of care provided by the NHS and throughout that time our efforts have been fuelled by the accounts we receive from patients and their relatives through our HelpLine on a daily basis.

As a consistent pattern of shocking standards of care has emerged we have decided to publish a number of these accounts to highlight the unacceptable experiences facing patients up and down the country on a regular basis...

Good point. Although no one in Congress or the White House in the US is actually advocating socialized medicine. There are examples of it, though, here; namely the VA and the military hospitals. Funny thing: the guys in Congress hollering most about socialized medicine, which is NOT on the table, are only too happy to get their care at Walter Reed or Andrews.

I don't think the VIP's are seeing the same doctors as the vets at Walter Reed. I also don't believe Barbra Streisand will ever be waiting in line at the same public clinic waiting to see the same doctor as the uneducated public if we go to the single payer system you advocate.

Actually, in taking a closer look at that post, it may have been off. You don't advocate a socialized system - and I won't assume it's just because you don't want to be an employee of the government and have the wages docked. Or do you? You seem to like the VA treatment. Either way, the vets aren't seeing the same docs as the VIP's and Barbra or the other Hollywood twits aren't ever going to wait in line with the masses - in that vaunted single payer system of yours!

About Me

Boring, Unoriginal, but Important Disclaimer:

What I say here is as true as I can make it, based on my experience as a surgeon. Still, in no way is it intended as specific medical advice for any condition. For that, you need to consult your own doctors, who actually know you. I hope you'll find things of interest and amusement here; maybe useful information. But please, please, PLEASE understand: this blog ought not be used in any way to provide the reader with ideas about diagnosis or treatment of any symptoms or disease. Also, as you'd expect, when I describe patients, I've changed many personal details: age, sex, occupation -- enough to make them into no one you might actually know. Thanks, and enjoy the blog.